Patients with posterior circulation stroke had longer prehospital delays and lower observed rates of intravenous thrombolysis than those with anterior circulation stroke, but stroke circulation was not independently associated with IVT after adjustment for ODT and other covariates.
Posterior circulation strokes made up about one third of ischemic strokes in this six-hospital Latin American cohort.
Onset-to-door time was longer in posterior circulation stroke than in anterior circulation stroke.
Intravenous thrombolysis rates differed between PCS and ACS, with lower observed rates in PCS.
Each additional hour of onset-to-door time was independently associated with lower odds of receiving IVT.
After adjustment, stroke circulation was not independently associated with receiving IVT.
Higher admission NIHSS was associated with higher odds of IVT.
Early recognition and reduction of prehospital delay are highlighted as potential targets to improve access to reperfusion therapy in Latin America.
This study looked at 1,460 adults with ischemic stroke (stroke caused by a blocked blood vessel) treated at six hospitals in Peru, Colombia, Chile, and Mexico between 2018 and 2023. About one third had strokes in the back part of the brain (posterior circulation), which are often harder to recognize. These patients took longer to reach the emergency department (a median of 13 hours vs. 8.5 hours) and were less often given clot-dissolving medication (intravenous thrombolysis). When the researchers accounted for other factors, the type of stroke itself was not clearly linked to getting thrombolysis. Instead, time mattered: each extra hour before arrival was linked to lower odds of receiving the treatment, while a higher stroke severity score on admission was linked to higher odds. This suggests that the lower treatment rate in posterior strokes may largely reflect delayed arrival rather than the stroke location itself. This research suggests that helping people and health systems recognize stroke symptoms sooner, including those of posterior strokes, and shortening the time to hospital arrival could improve access to reperfusion treatment in Latin America. The study is observational, so it shows associations rather than proving cause.
Huamani C, Mercado-Pompa A, León-Mantero A, Oré-Montalvo V, Baracaldo-Santamaría I, Puente-Vila H, et al.. (2026). Prehospital delay and thrombolysis rates in posterior circulation stroke: a multicenter Latin American study.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1941221